New indicator diseases reveal hidden HIV

12:06 March 1, 2012

Today, both heterosexuals and homosexuals in Europe are at particular risk of carrying HIV for so long that they remain undiagnosed until their immune system is under considerable pressure from the infection. An international study under the leadership of the HIV in Europe initiative has now revealed that a number of diseases, including herpes zoster and certain forms of cancer, should be on the list of indicators for HIV. The researchers behind the study conclude that when health care professionals meet patients presenting with these diseases they should recommend an HIV test. The new results and guidelines are to be debated at a major international HIV conference in Copenhagen on 19th and 20th March.

“At the HIV in Europe conference we will be discussing how to disseminate knowledge of the new HIV indicator diseases to non-HIV doctors and health care professionals across Europe,” says Jens Lundgren, Co-chair of the HIV in Europe initiative.

He’s also a professor of Viral Diseases at Rigshospitalet and the Faculty of Health and Medical Sciences at the University of Copenhagen, where he heads the Copenhagen HIV Programme, one of the leading HIV/AIDS centres in the world.

Too many HIV-infected individuals are remain undiagnosed

Half of all people living with HIV are diagnosed very late in the course of their chronic HIV infection. Heterosexuals now comprise 42 per cent of these late presenters, as a study of 90,000 Europeans tested HIV positive since 2.000 shows.

UNAIDS has estimated that 2,5 million Europeans carry an HIV infection, and as many as 900 000 of these, are still unaware of this. Inside EU the numbers are 800.000 infected with 250.000 undiagnosed.

Ton Coenen, co-chair of the HIV in Europe initiative, executive director of Aids Funds and Soa AIDS Nederland suggests that since the HIV/AIDS issue is no longer on the agenda in many European countries, and since people have to actively choose to be HIV-tested, many perhaps no longer consider going for a test if they have had unsafe sex.

However, the sooner HIV-infected individuals receive a diagnosis and start therapy, the greater are their chances of survival and their quality of life. And new research also shows therapy lowers the risk of passing the infection on to someone else.

“The currently situation shows that we need more effective testing strategies and guidelines,” Ton Coenen continues. “300 doctors, health care professionals, NGOs and health politicians from 40 European countries will be discussing this need at the conference on 19th and 20th March, so we have the ideal forum for it.”

Eight new HIV-defining diseases should warrant and HIV-test

“We already have a list of aids defining diseases, the vast majority of which indicate a weak immune system. This is a symptom of HIV and should result in an HIV test,” Professor Lundgren explains. “We wanted to find people living with HIV sooner than that, but that would require doctors and health care professionals to offer tests to people presenting with diseases indicative of a hidden HIV infection earlier in the course of the disease.”

The HIV in Europe initiative took up this challenge in 2009 and started the HIDES study (HIV Indicator Diseases Across Europe), which investigated eight new diseases and how often they proved to be signs of a hidden HIV infection among the 3588 patients in the study.

“We could see that if an adult had a sexually transmitted infection, malignant lymphoma, cervical or anal cancer/dysplasia, herpes zoster, hepatitis B or C, ongoing mononucleosis-like illness, inexplicable, persistent decline in the number of circulating white blood cells, or seborrheic dermatitis/exanthema, the risk of HIV infection was so high that it would be cost-effectiveness for society to routinely offer them a test,” Professor Lundgren says. He also emphasises that the new indicator diseases do not necessarily mean that the patient has HIV.

“But the incidence of HIV is greater for these eight indicator diseases and they should encourage health care professionals to offer the patient an HIV test. Draft guidelines on how to ensure this throughout Europe are one of the topics we need to debate and decide on, before they can be implemented.”

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